New data indicates whether endurance athletes have more cavities

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For decades, endurance athletes and their dentists have wondered if sipping on sugar-filled sports drinks puts their teeth at risk. You have a sugary, acidic drink that you are encouraged to sip frequently for hours on end, while exercising enough to reduce the flow of saliva that would otherwise protect your teeth. This is bad news.

Yet, despite the scary stories circulating from time to time, there isn’t much evidence to tell us just how serious this problem really is. Dental exams at the Olympic Village in 2012 revealed that 55% of athletes had cavities, which sounds bad until you consider that the overall prevalence of cavities among American adults is 92%. A small 2015 study found that the risk of cavities was proportional to hours of training in triathletes. On the other hand, Gatorade’s parent company funded a 2002 study that found no association between sports drink consumption and dental erosion, which probably doesn’t reassure you.

In other words, this is a question that requires more and better data. A new study in the Scandinavian Journal of Medicine and Science in Sport, from a group led by Cordula Leonie Merle and Lisa Richter of the University of Leipzig, is off to a humble start. They compared 88 elite endurance athletes, mostly runners and biathletes, all competing for German national or development teams, with 57 non-competitive amateur athletes. Importantly, unlike some of the previous studies in this area, they didn’t just ask about their health: all subjects received a detailed dental exam, including assessments of tooth decay, dental plaque, and gum health, from the same dentist.

The good news: Both groups had low levels of plaque, gum inflammation, and dental erosion. Both groups also had a similar number of decayed, missing or filled teeth: 2.7 for athletes, 2.3 for controls. But if you reduce that to decayed teeth, there was a significant difference: 0.6 for athletes, with a prevalence of 34%; 0.3 for controls with a prevalence of 19%.

There were a few other differences. Athletes also tended to have deeper pockets between their teeth and gums, which is a warning sign of periodontal disease. And they were more likely (43% vs. 25%) to have temporomandibular dysfunction, which indicates problems with jaw muscles or joints, such as clicking when you chew.

It’s hard to blame jaw clicking on sports drinks, which is an important point. Maybe competitive athletes are so flustered that they spend a lot of time clenching their jaws or grinding their teeth at night, or maybe there are underlying differences between the two groups that don’t have nothing to do with what they drink. For example, socio-economic status is one of the strongest predictors of dental health (high income people have more cavities overall, low income people have more untreated cavities).

The Leipzig study assessed oral hygiene habits such as toothbrushing and dental checkups, which were similar between the two groups. They didn’t assess specific behaviors like sports drink consumption. Overall, I don’t think the results convincingly prove that endurance athletes are at increased risk for dental problems, but they don’t rule it out either.

What can you do to protect yourself from this potential risk? A common tip is to rinse your mouth out with water after drinking sports drinks, both to clean your teeth and to promote saliva flow. The makers of Maurten, the hydrogel-encapsulated sports drink, have released data suggesting that their drink produces a less acidic biofilm on your teeth compared to other sports drinks.

But probably the most encouraging results I’ve seen come from a four-year randomized trial of 54 endurance athletes, mostly triathletes, half of whom tested a fancy new toothpaste and mouthwash containing stannous fluoride, a new fluoride compound that has antimicrobial properties in addition to the cavity-fighting and enamel-strengthening properties of ordinary fluoride compounds. The study was funded by the German subsidiary of Colgate.

The results of the trial were exceptionally encouraging. After four years, the chances of a given tooth surface showing signs of decay during the six-monthly check-up had been reduced by 25! It’s an amazing transformation. The key twist: There was no difference between the experimental and control group: the fancy toothpaste didn’t matter. Simply being enrolled in a study that required them to focus on their dental hygiene habits, as well as visits to a dentist every six months, drastically altered the subjects’ oral health. So that’s the radical advice I’m going to give you: brush your teeth, see your dentist for regular checkups, and keep training.


For more sweat science, join me on Twitter and Facebook, sign up for the email newsletter, and check out my book Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance.



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